In-Hospital Cardiac Arrest: A Study of Education in Cardiopulmonary Resuscitation and its Effects on Knowledge, Skills and Attitudes among Healthcare Professionals and Survival of In-Hospital Cardiac Arrest Patients

Abstract [en]

This thesis investigated whether out­come after in-hospital cardiac arrest patients could be improved by a cardiopulmonary resuscitation (CPR) educational intervention focusing on all hospital healthcare professionals.

Annually in Sweden, approximately 3000 in-hospital patients suffer a cardiac arrest in which CPR is attempted, and which 900 will survive.

The thesis is based on five papers:

Paper I was a methodological study concluding in a reliable multiple choice questionnaire (MCQ) aimed at measuring CPR knowledge.

Paper II was an intervention study. The intervention consisted of educating 3144 healthcare professionals in CPR. The MCQ from Paper I was answered by the healthcare professionals both before (82% response rate) and after (98% response rate) education. Theoretical knowledge improved in all the different groups of healthcare professionals after the intervention.

Paper III was an observational laboratory study investigating the practical CPR skills of 74 healthcare professionals’. Willingness to use an automated external defibrillator (AED) improved generally after educa­tion, and there were no major differences in CPR skills between the different healthcare professions.

Paper IV investigated, by use of a questionnaire, the attitudes to CPR of 2152 healthcare professionals (82% response rate). A majority of healthcare professionals reported a positive attitude to resuscitation.

Paper V was a register study of patients suffering from cardiac arrest. The intervention tended not to reduce the delay to start of treatment or to increase overall survival. However, our results suggested indirect signs of an improved cerebral function among survivors.

In conclusion, CPR education and the introduction of AEDs in-hospital

– improved healthcare professionals knowledge, skills, and attitudes

– did not improve patients’ survival to hospital discharge, but the functional status among survivors improved.

Abstract [en]

Background:

Guidelines recommend that all health care professionals should be able to perform cardiopulmonary resuscitation (CPR), including the use of an automated external defibrillator. Theoretical knowledge of CPR is then necessary. The aim of this study was to investigate how much theoretical knowledge in CPR would increase among all categories of health care professionals lacking training in CPR, in an intervention hospital, after a systematic standardised training. Their results were compared with the staff at a control hospital with an ongoing annual CPR training programme.

Methods:

Health care professionals at two hospitals, with a total of 3144 employees, answered a multiple-choice questionnaire before and after training in CPR. Bootstrapped chi-square tests and Fisher's exact test were used for the statistical analyses.

Results:

In the intervention hospital, physicians had the highest knowledge pre-test, but other health care professionals including nurses and assistant nurses reached a relatively high level post-test. Improvement was inversely related to the level of previous knowledge and was thus most marked among other health care professionals and least marked among physicians. The staff at the control hospital had a significantly higher level of knowledge pre-test than the intervention hospital, whereas the opposite was found post-test.

Conclusions:

Overall theoretical knowledge increased after systematic standardised training in CPR. The increase was more pronounced for those without previous training and for those staff categories with the least medical education.

Abstract [en]

Background: D-CPR (Defibrillator Cardiopulmonary Resuscitation) is a technique for optimal basic life support during cardiopulmonary resuscitation (CPR). Guidelines recommend that healthcare professionals can perform CPR with competence. How CPR training and provision is organized varies between hospitals, and it is our impression that in Sweden this has generally improved during the last 15-20 years. However, some hospitals still do not have any AED (Automated External Defibrillators). The aim was to investigate potential differences in practical skills between different healthcare professions before and after training in D-CPR. Methods: Seventy-four healthcare professionals were video recorded and evaluated for adherence to a modified Cardiff Score. A Laerdal Resusci Anne manikin in connection to PC Skill reporting System was used to evaluate CPR quality. A simulated CPR situation was accomplished during a 5-10 min scenario of ventricular fibrillation. Paired and unpaired statistical methods were used to examine differences within and between occupations with respect to the intervention. Results: There were no differences in skills among the different healthcare professions, except for compressions per minute. In total, the number of compression per minute and depth improved for all groups (P < 0.001). In total, 41% of the participants used AED before and 96% of the participants used AED after the intervention (P < 0.001). Before intervention, it took a median time of 120 seconds until the AED was used; after the intervention, it took 82 seconds. Conclusion: Nearly all healthcare professionals learned to use the AED. There were no differences in CPR skill performances among the different healthcare professionals.